It’s not often a birthday cake disappoints me. After all, who doesn’t love birthday cake?

But this one did.

I know, I know, it’s supposed to be funny – and I admit, it’s an excellent cake in terms of technique – it looks so amazingly real! I found it on Facebook (of course), and the story goes that the lady whose birthday it was chose this cake herself, because she wanted something different and funny for her birthday.

And maybe I just have no sense of humour, but as someone who works in women’s health, I just don’t find incontinence funny. I’ve also spent a few years working in aged care facilities in the past, and as anyone who has worked in this industry can tell you – incontinence is no laughing matter in aged care.

Did you know continence issues are one of the major reasons people are admitted to aged care facilities – when they can no longer manage their own continence, and their family can’t (or won’t) manage it for them. It’s heartbreaking.

Did you also know that continence issues are one of the leading causes of falls in the elderly? So many falls happen overnight during toilet trips. And with falls come other injuries, such as fractures and head injuries. And so it goes that continence becomes a much bigger problem, and absolutely not a laughing matter.

But when you’re just 50 years old – and aged care isn’t even on the horizon, it’s just fun, fun, funny. Right?

I think the issue here is that it’s an “if you can’t laugh at it, you’ll cry” sort of situation. Incontinence, or “leakage” is something that affects so many women. It’s extremely common, but it’s also extraordinarily embarrassing, shameful and life altering. Women make all kinds of changes to their daily lives to avoid or hide their “leakage” issues. Which is why we laugh at it – because it’s easier to pretend it’s funny, rather than the fact that it’s destroying our self confidence and self concept.

Because I’m a big fan of prevention and early intervention I often talk about pelvic floor health for new Mums on my site. But I can and do work with woman of all ages. In fact, the majority of my clients at the moment are women whose children are school age. And yes, I’ve even worked with 50 year olds!

I think perhaps the issue is that I use the term “postnatal” a lot. Because I’m guessing most people associate “postnatal” to those first 12 months or so after birth.

But I have a little phrase I like to use:

“Once you’re postnatal, you’re always postnatal”.

Basically that means that the issues that can affect you in that first year after childbirth can actually stick around for a a very long time, years, decades even. But the good news is that you can address it, it’s never too late to work on improving your pelvic floor function. Just because you’ve leaked for the past five, 15 or 25 years, doesn’t mean that you couldn’t be dry again. You just need the right support to help you reach that goal – that is, if like me, you don’t think it’s a laughing matter.

If you want help, or know someone who might want help, please contact me, even if it’s just to clarify any queries or questions you might have.

Whenever I talk to mothers (and fathers) about toilet training toddlers I always start with the suggestion that learning how to go to the toilet is a REALLY big task! Sure, we now do it on autopilot (most of us at least), but let’s look at all the steps involved in being able to successfully do a wee in the toilet:

You have to be aware of the urge to urinate

You have to recognise that urge in enough time to allow you to make it to the toilet

You have to find your way to the nearest bathroom

You have to be able to remove your clothing and underwear

You have to be able to shift your body weight onto and off of the toilet

You have to have the neural control required to release the urine from your bladder

You have to have the ability to sense when your bladder is fully empty

You have to have the manual handling skills to tear the toilet paper from the roll and wipe your perineum

You have to be able to stand up from a seated position

You have to be able to re-dress yourself

You have to be able to remember to flush the toilet and wash your hands.

Phew! It’s no wonder toddlers take a while to get the hang of it! Ask my three-year old – she’ll tell you!

Learning to wee? There’s more to it than you think.

So what’s my point here? Well, toileting is a really complicated task. There are several body systems and processes at play in mastering the cognitive and physical elements within it, and it also requires us to integrate those systems and processes to work together. Which is why it takes us so long to learn how to do it as toddlers – and why we tend to have so many accidents.

Frequently, I come across parents who are frustrated at how long it’s taking their child to toilet train. I find encouraging them to remember the enormity of this task – all 11 points listed above – helps shift their mindset around their child’s toilet training.

Which brings me to the topic of postnatal incontinence and pelvic floor dysfunction.

This is a common issue impacting on many postnatal women. Most recently given the less confronting title of “leakage”, postnatal incontinence has the potential to dramatically impact on a woman’s life. It can lead to issues with embarrassment, low confidence and self esteem, it can lead to women ceasing or reducing their favourite social, recreational and sporting activities, it change how they see themselves as a woman. At the extreme end, it can lead to serious mental health conditions such as depression or social anxiety. It’s difficult to feel free, spontaneous, athletic or sexy when you’re worried your pelvic floor is going to let you down. There’s such a stigma about incontinence in our society that it’s rarely spoken about out loud, and when it is, it’s almost always spoken on in diminished terms “leakage”, “light bladder leakage”, “LBL”.

Just like toilet training a toddler, dealing with adult incontinence also requires us to step back and look at a range of body systems and processes. Unfortunately the common understanding by the general public is that this issue is just related to weak pelvic floor muscles, which is not entirely true. Certainly the functional capacity of the pelvic floor musculature has a huge role in regaining and maintaining continence. But what else is there to consider?

Our overall posture:How we stand or sit throughout the day impacts on the length and function of our body’s postural muscles – many of which have connections with the pelvis and the pelvic floor muscles. Imbalanced postural muscles can impact the way our pelvic floor muscles function.

How we breathe: did you know the diaphragm (the muscle under your lungs) is designed to work in unison with the pelvic floor? To maintain good ‘intra-abdominal pressure’ they should work together – when the diaphragm contracts downwards the pelvic floor should relax downwards. When the diaphragm relaxes up, the pelvic floor should lift up. By the time we reach adulthood so many of us have developed poor breathing patterns, and we’ve lost our ability to breathe properly, or connect our breath with our pelvic floor.

What we eat and drink: A common tactic used by many women to address incontinence is to simply reduce their fluid intake. This is a huge no-no as it means the bladder becomes used to only holding small amounts of urine. Over time, it can lose it’s capacity to stretch to it’s previous size. To maintain good continence, we want the bladder musculature as functional as possible. Also, were you aware that caffeine is a stimulant for the bladder? Sometimes eliminating coffee from our diet can be a big piece of the puzzle.

Our habits: Going to the loo ‘just in case’, or because your friends are; ‘holding on’ because you want to avoid public toilets while away from the house; how about running the tap while you pee to avoid the embarrassment of someone hearing your stream on urine? We women have terrible habits when it comes to toileting – but honestly, it’s probably not our fault, it’s something we have drilled into us from an early age as young girls. The problem is, when our toilet habits become habitual or situational, it means we lose that important mind-body connection between our brain and our bladder. When we lose that connection, we lose the trust in our own bodies, and that has a huge impact on continence.

Poor toileting habits early in life can lead to continence issues down the track.

Our mental health: It’s a two way street – continence issues can increase the likelihood of mental health problems, such as depression and anxiety, but these conditions can also impact the prevalence of continence issues. When we experience depression, anxiety or social phobia, our habits and lifestyles change – which means that every one of those four areas listed above can be impacted. It changes our posture, our breathing, our nutrition and our habits. All of which can lead to pelvic floor difficulties.

Did someone say vicious cycle?

So you can see that treating pelvic floor issues is about so much more than just strengthening those pelvic floor muscles. The list above is by no means exhaustive either. But it’s enough evidence to be able to say that addressing incontinence and pelvic floor dysfunction requires a truly holistic view of the individual involved.

The good news is there’s so many wonderful health practitioners out there who can support you if you need help with this area. incontinence is not something you have to live with. It can be treated, but for best treatment, you need someone who is going to look at the whole you – not just your pelvic floor. Search around for a Women’s Health OT (like me), or a Women’s Health physiotherapist, those of us who specialise in this area know that taking an integrated approach is the best, and only, answer.

Until next time, be well.

Cheers, Sarah xx

ps. If you want to know more about how to restore your pelvic floor function after having a baby, make sure you check out my Body Mind Baby postnatal wellbeing program. This 10 week online program covers a wide range of physical and emotional challenges faced by new mothers – with information and simple, practical strategies you can implement in your everyday life to positively impact your wellbeing – you can check it out here.